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Most patients suffering from hydrocephalus have been treated by insertion of differential pressure valves that have fairly constant resistance. The number of shunting procedures for hydrocephalus has increased significantly with the advent of more sophisticated diagnostic tools such as computed tomographic scanning and with rapid technical advances in shunt equidment. Since intracranial pressure is a variable parameter depending on the factors as patients position and since cerebrospinal fluid(CSF) secretion is almost constant, it may be assumed that some shunt complication are related to too much or too little CSF drainage. As a result, there has been a proliferation of shunt systems that differ in their component parts, particularly their valve mechanisms. To minimize complications and to maintain proper shunt functions, the shunt system optimal to each pathological condition must be selected out of variety of systems. To effect this, it is imperative to have an accurate knowledge of the structure and characteristics of each shunt is currently available. The author reviews some of the devices currently in use for the purposes of clarification and comparison. Also clinical results of 33 padiatric patients shunted with a valve which was selected out of a variety of shunt system, are reported.
The introduction of the operating microscope improved not only the immediate operative management of cerebral aneurysms, but also the knowlege of their topography. The origin and projection of an aneurysm and its relation to the arteries concerned, identification and sparing of small functionally important arteries in the vicinity of the aneurysm, and the recognition of less known anomalies of the vascular system became as important as the dissection and clipping of the neck itself. We have presented 2 patients with aneurysms arising from the carotid artery in the origin of the ophthalmic artery. The origins and projections of aneurysms were analyzed with the aid of angiography, magnification technique, operative drawing and photographs. To facilitate the surgical procedures and results in lowered morbidity we have discussed the technical considerations for medialward directing aneurysm under the optic nerve in the view point of the surgical anatomy. We emphasized preoperatively defined plans concerning the origin, direction and size of the aneurysms, as well as, constant awareness of topographic relations.
Cerebral somatosensory evoked potentials(SEPs) produced by stimulation of peripheral nerves provide a useful diagnostic index of conduction in somatosensory pathways to the cortex. Thus the integrity of both dorsal column-medial lemniscus pathway and primary sensorimotor area has been considered an essential requirement to record a nomal SEP. There are suggestions that SEPs contain several components arising from different neuronal sources, the early short latency potentials corresponding to the lemniscus-mediated responses and the late waves to the diffuse spino-thalamic projections. The present work analyses the influence on SEPs of focal brain lesions, using the computerized tomography in detecting and localizing brain lesion. Somatosensroy evoked potentials were recorded in 20 patients with focal brain lesions recognized by computerized tomography. 1) Patients with primary sensorimotor area (PSMA) damages (group Ⅰ) had a very abnormal of the early component (No, Po, N1, Pl) in 100% on the lesion side. 2) Patients presented supratentorial lesions, sparing PSMA (group Ⅱ), 87.5% showing abnormal SEPs in early components and characterized by increment of amplitude in late components. 3) Brainstem damage (group Ⅲ) produced a distortion of the early components especially N11, N20 msec latency. 4) In incomplete spinal cord injuries, the SEPs is indeed signal of functional recovery, of posterior column and incorrespondance with clinical improvement.
There were 11 cases of pituitary tumors and 2 cases of craniopharyngiomas, who were admitted to the Department of Neurosurgery of the Catholic Medical Center from July 1976 to April 1977. The authors analyzed changes of the hormone related with the hypophyses before and after surgery, and radiation -using the radioimmunoassay according to Schalch and Parker's double antibody method. The hormonal assays were performed as follows: 5 samplings of growth hormones were given at a fasting state, at 8 AM, 8 : 30 AM, 10 AM and 11 AM, also the oral glucose tolerance test simultaneously after the patients were given 100 gm of surgar, associated with the insulin tolerance test (0.15 unit/㎏). Two specimens of blood for the prolactin were withdrawn at 8 AM and 4 PM on that day. A specimen for LH, FSH, TSH, T3, T4 and cortisol was taken at 8 AM. The 8 surgery cases of the pituitary tumors associated with post-operative radiation underwent 3 transsphenoidal approaches, 3 transfrontal and 2 transtemporal approaches, and all of the surgery cases were alive. The transtemporal approach was for all craniopharyngiomas, and all of them died following surgery. One patient in this chromophile adenoma group had radiation therapy only. Following the clinical improvement after the treatment, the endocrinological symptoms, i.e. diminished libido and amenorrhea, were improved in the acromegalic group. The visual disturbance in the chromophobe adenoma group was markedly improved and the menstruation had started in one case. In inoperative patients,, the visual disturbance and the endocrinological disarrangements were aggravated. In the chromophile adenoma group accompanying the acromegaly, the mean value of the plasma growth hormone was markedly increased to 61.3 ng/㎖ and greatly decreased to 36.8 ng/㎖ after the surgery and radiation, but increased rather than before radiation in the one case of radiation only. The mean prolactin value was also increased to 60.6 ng/㎖ and not changed after the therapy. The gonadotropin was within normal limits and tended to decrease slightly after the treatment. The TSH, T3, T4 and cortisol were within normal values. In the chromophobe adenoma group, the mean growth hormone values were within normal limits, 7.27 ng/㎖, and not altered after the therapy. The mean prolactin value was increased to 57.8 ng/㎖ and not changed after the treatment. The gonadotropin, TSH, T4 and cortisol were within normal limits before and after the treatment, but the T3 value was slightly higher than normal. In the craniopharyngioma group, the mean growth hormone value was within normal limits, 7.4 ng/㎖ and not altered after the surgery. The mean prolactin, gonadotropin, TSH, T3 and T4 were within normal limits but the cortisol value was increased to 13.7 ng/㎖ after the surgery.
Ninety three patients, who sustained craniocerebral injuries were studied and followed up for detection of syndrome of inappropriate secretion of antidiuretic hormone from their admission to the time of their recovery. Their electolytes in serum and urine, and fluid balance were examined at frequent intervals. Ten cases have manifested "The Syndrome of the Inappropriate Secretion of Antidiuretic Hormone"(S.I.S.A.D.H). 1. For the detection of the presence of S.I.S.A.D.H., body weight, fluid balance, central venous pressure, sodium, potassium, chloride, B.U.N. and creatinine content of the serum as well as sodium, potassium, chloride and 17-ketesteroid content of 24 hours urine specimen had been measured every 2 or 3 days interval, from their admission. 2. To establish the diagnosis of S.I.S.A.D.H., the following conditions were observed. First, there was no evidence of dehydration, second, the level of the sodium content of the serum was decreased below125mEq/L and third, the amount of urinary sodium was persistently increased. However the functions of the kidney and adrenal gland were normal. 3. In the cases of S.I.S.A.D.H. among Korean craniocerebral injuries, the amount of sodium excreted in the urine was above 110mEq/L. On the other hand, 27 Koreans without craniocerebral injury or pulmonary complication, who had hospital diet which contained about 15gms. of NaCl, the average value of sodium excreted in the urine was 95mEq/L although there had been great individual differences. 4. Out of 33 patients with brain contusion, 4 manifested S.I.S.A.D.H., 27 with epidural hematoma there were 4 cases, of 15 cases of subdural hematoma, there was one case and also one cases of S.I.S.A.D.H. was found among the 11 cases of compound comminuted depressed fracture of the skull. 5. Among the 93 cases of craniocerebral injuries, 10 of them which is equivalent to 10.8% developed S.I.S.A.D.H.. In there cases, improvement of the syndrome was observed in a few days by limitation of daily in take to 600cc. The patient who has shown rather severe hyponatremia, the condition was improved by parenteral injection of 3% saline solution with fluid restriction. 6. Among the cases with S.I.S.A.D.H. it was discovered that 3 of them had infection or complications of the lung. 7. Clinical findings among these patients with S.I.S.A.D.H. were: Three cases had mental disturbance, two with anorexia, one had vomiting and one with convulsions. In all the cases consciousness and muscular activity were somewhat impaired. 8. Aside from the patients with croniocerebral injuries, S.I.S.A.D.H. was observed in one case of aneurysm of the anterior communicating artery.